Background:
The aim of this study was to quantify the prevalence of cervical smear abnormalities in sexually active adolescents and identify the effect of immune-modifying conditions.
Methods:
Two hundred seventy-one females ages 13-22 years attending a clinic for sexually transmitted disease (std) evaluation had cervical papanicoloau (pap) smears and completed sexual history questionnaires. results of all follow-up pap smears were obtained. medical charts were available for 54 patients with cytologic follow-up and were reviewed for the presence of immune-modifying conditions. follow-up smear results for patients with and without immune-modifying conditions were compared. abnormality rates for all cervical smears seen in 1995 at montefiore medical center were also obtained.
Results:
The smear abnormality rate for adolescents was 20. 7% (abnormal squamous cells of undetermined significance [ascus], 12. 2%; low grade squamous intraepithelial lesion [lgsil], 7.7%; high grade squamous intraepithelial lesion [hgsil], 0.7%) compared with all adult females, for whom the rate was 13.2% (ascus, 9.9%; lgsil, 2.5%; hgsil, 0.6%; carcinoma 0.2%) (p < 0.0002). of 20 initial ascus patients, 6 (30%) showed lgsil or hgsil on follow-up. chart review allowed the clinical immune status of 54 patients to be determined. of 14 patients with an immune-modifying condition (9 hiv positive patients, 3 receiving oral steroids, 1 liver transplant patient receiving steroids, and 1 with intestinal lymphangiectasia), 11 (78. 6%) developed or maintained an abnormality on cytologic follow-up. of 40 patients with no identifiable immune-modifying condition, 11 (27.5%) developed or maintained an abnormality on cytologic follow-up (p < 0.00082).
Conclusions:
Sexually active adolescents are at higher risk of developing a significant cervical smear abnormality, especially lgsil. patients with an atypical pap smear or immune-modifying condition require more attentive gynecologic monitoring. cancer (cancer cytopathol)